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Biomedical subjects

P M Emmelkamp

Publications and source records attributed to P M Emmelkamp.

At least 19 recordsLinked to original sources
PubMed2001

Interapy, treatment of posttraumatic stress through the Internet: a controlled trial.

On-line therapy offers many advantages over face-to-face settings. Interapy includes psycho-education, screening, effect measures and protocol-driven treatment via the Internet for clients. The present paper reports the results of a controlled trial on the Interapy treatment of posttraumatic stress and grief in students, gaining course credits. The participants in the experimental condition (n = 13) improved significantly than the participants in the waiting-list control condition (n = 12), on trauma-related symptoms and general psychopathology. The effect sizes were large. Eighty percent of the treated participants showed clinically significant improvement after treatment. The possibilities for future research with Interapy, including studies into moderating variables, are discussed.

Adolescent↗
PubMed2001

Virtual reality treatment in acrophobia: a comparison with exposure in vivo.

The aim of the present study was to evaluate the effectiveness of low-budget virtual reality exposure versus exposure in vivo in a within-group design in 10 individuals suffering from acrophobia. Virtual reality exposure was found to be at least as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), and even more effective on the Attitude towards Heights Questionnaire (AHQ). The present study shows that virtual reality exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies are recommended, in which virtual reality exposure is compared with in vivo exposure in a between-group design, thus enabling investigation of the long-term effects of virtual reality treatment.

Adult↗
PubMed2001

Traumatic distress among support-seeking female victims of stalking.

OBJECTIVE: The authors examined the nature and prevalence of stalking behaviors, victims' coping responses, and the psychomedical impact of stalking on its victims. METHOD: Widely accepted self-report measures, including the 12-item General Health Questionnaire and the Impact of Event Scale, were used to assess characteristics of the stalking history and its outcome in terms of general psychomedical distress and posttraumatic stress in a community study group of 201 female stalking victims. RESULTS: The majority of the victims had undergone multiple forms of harassment, including threats of violence in 74% (N=148) and actual violence in 55% (N=111). More than half of the victims met the criterion for clinically significant pathology on the General Health QUESTIONNAIRE: Stalking often yielded substantial posttraumatic stress symptoms, commensurate with levels found in other studies of traumatized subjects. CONCLUSIONS: Support-seeking female stalking victims experience pervasive and persistent threat and intrusion; these experiences lead to high levels of psychological morbidity.

Adaptation, Psychological↗
PubMed2001

The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners.

In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.

Adult↗
PubMed2000

Implementing a stress management training: comparative trainer effectiveness.

Participants who were recruited from various organizations were randomly assigned to 1 of 2 stress management training (SMT) conditions or an assessment-only control group. The groups in the 1st SMT condition were led by external clinical psychologists. The groups in the 2nd SMT condition were led by individuals who held posts within the organizations involved, referred to as paraprofessionals. Results show favorable effects of the SMT program both in the short term as well as at 6-month follow-up. Results showed no serious differences in effectiveness between trainers. It is argued that, to be effective, the SMT program does not necessarily have to be given by clinical psychologists only but may instead be given by individuals from other professional orientations.

Adaptation, Psychological↗
PubMed2000

Stalking--a contemporary challenge for forensic and clinical psychiatry.

BACKGROUND: Stalking is causing pervasive and intense personal suffering and is an area of psychiatry that is currently overlooked. AIMS: To review demographic and clinical characteristics of stalkers as well as the psychological consequences for victims of stalking. METHOD: A Medline and PsycLit search was conducted on stalking, forensic psychiatry, personality disorders, de Clérambault syndrome and erotomania, with respect to the relevance of the articles selected for stalking. RESULTS: Stalkers are best thought of as a heterogeneous group whose behaviour can be motivated by different forms of psychopathology, including psychosis and severe personality disorders. CONCLUSIONS: There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.

Crime Victims↗
PubMed2000

Internet-mediated, protocol-driven treatment of psychological dysfunction.

An Internet system was developed for assessing psychopathology, for on-line, protocol-driven cognitive-behavioural psychological treatment and for measuring the effects of treatment. The system focused on the treatment of post-traumatic stress. The treatment comprised 10 writing sessions (45 min each) over five weeks. Participants were assessed on-line before treatment, after treatment and after six-week follow-up. After treatment the participants had improved significantly in terms of post-traumatic stress symptoms (P < 0.005) and general psychological functioning (P < 0.005), and this was sustained during the follow-up. Nineteen of the 20 participants were clinically recovered after treatment. Reduction in post-traumatic stress symptoms compared favourably to changes in control and experimental groups in trials of similar but face-to-face treatment.

Adult↗
PubMed1999

Prediction of treatment outcome in social phobia: a cross-validation.

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.

Cognitive Behavioral Therapy↗
PubMed1999

A comprehensive model of stress. the roles of experienced stress and neuroticism in explaining the stress-distress relationship.

BACKGROUND: In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the level of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping. METHODS: A covariance path analysis technique (LISREL) was used. RESULTS: A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism. CONCLUSION: Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality.

Adaptation, Psychological↗
PubMed1999

Assessment of obsessive-compulsive disorder.

Self-report assessment devices of obsessive-compulsive symptoms are widely used by behavior therapists. In the present investigation, psychometric characteristics and concurrent, discriminant, and factorial validity of the Maudsley Obsessional Compulsive Inventory (MOCI) were studied in clinical samples. Test-retest reliability was high. The internal consistency was high for the total score and moderate for the subscales, checking and cleaning. The slowness and doubting subscales appeared to be less useful. The MOCI was found to reliably discriminate between obsessional patients on one hand and normals, patients with anorexia nervosa and anxiety disorders, on the other, but failed to discriminate obsessionals from depressives. Concurrent validity and factorial validity were satisfactory. The MOCI may be used to evaluate effects of treatment, but it is less sensitive than target ratings of obsessional problems.

Adolescent↗
PubMed1998

The effects of a stress-management training program in individuals at risk in the community at large.

In this study we examine the effects of a stress-management training program on individuals without serious (mental) health complaints but with an increased chance of developing them as a consequence of stress. Potential subjects were randomly selected from the community at large and, then screened for participation in the training program if some of several (mental) health risk factors could be attributed to them: past life-events, neuroticism, inassertiveness, avoidant coping style and lack of social support. The control group, which did not take part in the training program, consisted of individuals with a similar risk profile as those in the training group. The training program consisted of several stress-management techniques: changing unhealthy life-style, relaxation training, problem-solving training and social skills-training. Multivariate analyses of variance showed that the training group, as compared to the control group, reported significantly less distress, less trait anxiety, less daily hassles, more assertiveness and more satisfaction with social support at follow-up. There were, however, no significant changes found in the coping skills of either group.

Adaptation, Psychological↗
PubMed1997

The impact of personality disorders on behavioral treatment outcome for social phobia.

The impact of personality disorders (PDs) on exposure in vivo treatment for social phobia was investigated in three groups of social phobics: social phobia without any PD (n = 30), social phobia with a single diagnosis of avoidant PD (n = 18) and social phobia with multiple PDs (n = 13). We hypothesized parallel change for social phobia with and without an avoidant PD with the latter group being more impaired before and after treatment. In order to test this hypothesis, confidence intervals for change were computed. In line with our hypothesis, social phobics in all three groups improved significantly during treatment and no interaction effects were found on the repeated MANOVAs. By using a confidence interval, parallel change was found on most measures. The impact of additional anxiety and mood disorders on treatment outcome was investigated separately. The analyses showed that an additional anxiety or mood disorder also did not predict outcome of exposure treatment.

Adult↗
PubMed1997

Spouse-aided therapy with depressed patients.

Twenty-three non-maritally distressed depressed patients who were married or cohabitating were randomly assigned to either individual behavioral-cognitive therapy or spouse-aided treatment. Both treatment conditions focused on depressed mood, behavioral activity, and dysfunctional cognitions, the difference being that in the spouse-aided treatment the partner was involved in all aspects of treatment, whereas in the individual condition the partner was not involved. MANOVAs revealed that treatment led to statistically significant improvement on depressed mood, behavioral activity, and dysfunctional cognitions. Treatment did not affect relationship variables (marital satisfaction, communication, and expressed emotion) for both spouses. Spouse-aided therapy was as effective as individual cognitive-behavior therapy.

Adolescent↗
PubMed1996

The Survey of Recent Life Experiences: a psychometric evaluation.

Hitherto, various critics have claimed that the most commonly used measure for daily hassles is confounded with psychological well-being in both content and format. In order to circumvent such contamination, the Survey of Recent Life Experiences (SRLE) was developed by Kohn and MacDonald (1992). In the present study, the SRLE was psychometrically evaluated within a general sample of the Dutch population. Confirmatory factor analysis showed that, with the exception of one item, the original six-factor structure was strongly replicated. For five of six factors, internal consistency reliabilities proved satisfactory. It is argued that the rather low internal consistency reliability of the sixth factor may be improved if additional items are subjoined. In addition, yielded relationships between the SRLE and other variables were in accordance with previous research. It is therefore argued that the results are in support of cross-cultural construct validity of the SRLE. Future use within other Western European societies is recommended.

Adult↗
PubMed1996

The assessment of personality disorders: implications for cognitive and behavior therapy.

This article reviews the comorbidity of personality disorders (PDs) and Axis I disorders and discusses implications for assessment and treatment. Pros and cons of various assessment methods are discussed. The co-occurrence of PDs with Axis I disorders is considerable; roughly half of patients with anxiety disorders, depressive disorders or eating disorders received a PD diagnosis. Comorbidity models are discussed and implications for assessment and treatment are provided. Regarding the impact of PDs on cognitive-behavioral treatment outcome for Axis I disorders, conflicting results are found due to differences in assessment methods, treatment strategies, and patient samples. It is argued that additional Axis I pathology should be taken into account when studying the impact of PDs on treatment outcome for the target Axis I disorders. Finally, it is argued that the interpersonal behavior of the PD patient and the therapeutic relationship deserve more attention in the assessment and treatment of patients with PDs.

Comorbidity↗
PubMed1996

Treatment of fear of blushing, sweating, or trembling. Results at long-term follow-up.

This study investigated the long-term effectiveness of cognitive-behavioral treatments for patients with a specific type of social phobia: fear of showing bodily symptoms (blushing, sweating, or trembling). Patients were reassessed 18 months after they had finished one of the following treatments: (a) exposure in vivo followed by cognitive therapy, (b) cognitive therapy followed by exposure in vivo, or (c) a cognitive-behavioral treatment in which both strategies were integrated from the start. All patients were individually treated. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs for the patients who completed the 18-month follow-up (n = 26) demonstrated significant time effects from pretest to follow-up, indicating overall improvement. Between the posttest and the 18-month follow-up, no significant change was observed. No differences among the treatment packages were found, although the cognitive-exposure treatment showed a trend to be less effective than both other treatments.

Adolescent↗
PubMed1996

Individual behavioural-cognitive therapy v. marital therapy for depression in maritally distressed couples.

BACKGROUND: Depressed patients are often characterised by marital distress, but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction. METHOD: Twenty-seven depressed patients experiencing marital distress were randomly assigned to either individual behavioural-cognitive therapy or marital therapy. The individual treatment condition focused on depressed mood, behavioural activity and dysfunctional cognitions, whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship. MANOVAs revealed that treatment led to statistically significant improvements in depressed mood, behavioural activity and dysfunctional cognitions, an increase in relationship satisfaction and improvement of communication in patients and spouses. A significant interaction effect was found, showing that marital therapy had more impact on relationship variables than the individual treatment. CONCLUSION: Both individual cognitive-behaviour therapy and marital therapy lead to less depressive complaints, and both treatment conditions have a positive effect on the relationship, although the effect on the relationship is significantly stronger in couples who were tested by marital therapy compared with patients who were treated individually.

Adult↗